Current Research Results
Child Maltreatment and Migraine (Parts I, II, and III)
Migraine and Obesity : Epidemiology, Mechanisms and Implications
The Prevalence of Neck Pain in Migraine
Child Maltreatment and Migraine (Parts I, II, and III)
Gretchen E. Tietjen, MD; Jan L. Brandes, MD; B. Lee Peterlin, DO; Arnolda Eloff, MB,CHB,MME; Rima M. Dafer, MD, MPH; Michael R. Stein, MD; Ellen Drexler, MD; Vincent T. Martin, MD; Susan Hutchinson, MD; Sheena K. Aurora, MD; Ana Recober, MD; Nabeel A. Herial, MD, MPH; Christine Utley, MSN, CNP; Leah White, MPH; Sadik A. Khuder, MPH, PhD
January 2010 (Volume 50, Issue 1, Pages 20 - 51)
Patient Summary, Autumn Klein, MD, PhD
In these articles, Dr Tietjen draws the associations between migraine headaches and physical and emotional abuse and neglect in childhood and adulthood. From eleven headache centers, 1348 patients (88% were women, average age 41) responded and almost 60% reported some form of abuse or neglect in childhood; the most common was emotional abuse. Of those who experienced childhood abuse, 43% were re-victimized in adulthood. Depression was noted in 28% and anxiety in 56% with higher rates in those experiencing childhood trauma. Physical and emotional abuse and neglect were significantly associated with chronic migraine (>15 days/month) and transformation of migraine from episodic (<15d/month) to chronic migraine. Additionally, those with a history of abuse had earlier onset of migraine.
Childhood abuse is known to be associated with increased rates of depression, anxiety, and headache, but this is the first study that has documented this in a migraine population. While these findings are not surprising, the rates of abuse and neglect are much higher than expected. For those with a history of childhood abuse, these articles highlight the need for a therapist or psychiatrist to be involved in the migraine treatment team to provide optimal care.
Click below to read the articles:
Part I: Prevalence and Adult Revictimization: A Multicenter Headache Clinic Survey
Part II: Emotional Abuse as a Risk Factor for Headache Chronification
Part III: Association With Comorbid Pain Conditions
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Migraine and Obesity: Epidemiology, Mechanisms, and Implications
B. Lee Peterlin, DO; Alan M. Rapoport, MD; Tobias Kurth, MD, ScD
EarlyView, November 2009
Patient Summary, Autumn Klein, MD, PhD
Obesity affects almost one third of American, reduces quality of life, and increases morbidity and mortality. Obesity also increases pain from increased weight and structural changes, but it is unclear how obesity can increase other painful processes such as migraine. This article reviews the literature on obesity and migraine. Many studies use body mass index (BMI; a function of height and weight or kg/m2) as a surrogate for obesity and a measure of body fat. Body mass index < 18.5 is underweight, 18.5-24.9 is normal, 25-29.9 is overweight and >30 is obese. The distribution of body fat into total body obesity (TBO) and abdominal obesity (Ab-O) can also predict future disease. Men have more Ab-O, but Ab-O also increases in postmenopausal women. Chronic daily headache (CDH; headache for >15 days of the month) is increased in TBO and the transition from episodic headache to CDH is increased in TBO. Migraine is also increased in those who are underweight and TBO. Interestingly, older men and women (those >54 years old) had no association with migraine and TBO. In young people, it seems that migraine is increased in those with Ab-O, but this is not the case in older men and women. This article also discusses hormonal influences of headache, appetite, and obesity. While the precise mechanisms are not fully known, these substances, serotonin, orexin, adiponectin, and leptin, have been shown to modulate pain and inflammation, two main features of headaches and migraines.
Obesity is difficult to measure directly, so indirect measures like BMI are used in these studies. In addition, many of these studies relied on participants their measurements and headaches so height is likely over-reported and weight under-reported, resulting in an inaccurate BMI. However, for many reasons in addition to reducing headache and migraine, it is still important to maintain a moderate weight.
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The Prevalence of Neck Pain in Migraine
Anne Calhoun, MD; Sutapa Ford, PhD; Cori Millen, DO; Alan Finkel, MD; Y. Nie
Early View, February 2010
Patient Summary, Autumn Klein, MD, PhD
In this study, the authors compared how often patients got nausea or neck pain with their migraines. Patients at headache clinics and in the general community were included and patients with fibromyalgia and cervicogenic headache (neck pain with limitation of movement of the neck) were excluded. Almost all of these patients were women and half of them had chronic daily headache (headache for >15 days of the month). They found that neck pain was more common at any intensity of headache and that the number of patients reporting neck pain increased with increasing frequency of headaches.
Comment:
Neck pain is often not recognized as a significant symptom associated with migraine. This article shows that neck pain is more common than nausea in migraine patients. It also emphasizes that this symptom is not mentioned by patients, and doctors do not often ask about it. Neck pain may serve as a signal (warning) for impending migraine and may be a better standard by which to gauge severity of migraine and measure treatment.
Click here to read the article
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